Perceptions and challenges of online teaching and learning amidst the COVID-19 pandemic in India: a cross-sectional study with dental students and teachers

Background Online education has emerged as a crucial tool for imparting knowledge and skills to students in the twenty-first century, especially in developing nations like India, which previously relied heavily on traditional teaching methods. Methods This study delved into the perceptions and challenges experienced by students and teachers in the context of online education during the COVID-19 pandemic. Data were collected from a sample of 491 dental students and 132 teachers utilizing a cross-sectional research design and an online-validated survey questionnaire. Results The study’s findings revealed significant insights. Internet accessibility emerged as a major impediment for students, with online instruction proving more effective for theoretical subjects compared to practical ones. Although most teachers expressed comfort with online teaching, they highlighted the absence of classroom interaction as a significant challenge. Conclusion This study comprehensively examines the perspectives of both students and teachers regarding online education during the pandemic. The results carry substantial implications for the academic community, underscoring the need to address internet access issues and explore ways to enhance engagement and interaction in online learning environments. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-024-05340-2.


Introduction
The COVID-19 pandemic has undeniably reshaped the global educational landscape, forcing a rapid shift towards online learning methodologies.While some disciplines have transitioned relatively smoothly, dental education presents unique challenges.Unlike fields with a primarily theoretical foundation, dental education hinges on the development of practical skills and direct patient interaction [1,2].This inherent need for handson clinical experience necessitates a critical examination of online learning's suitability for dental education [1].
Research across diverse international contexts underscores the limitations of online learning alone in fostering essential technical skills in dentistry [3,4].Recognizing this reality, the Indian dental education model prioritizes hands-on learning as a core curricular element.However, the pre-clinical phases often incorporate simulations using mannequins, hinting at the potential for blended learning approaches.In this scenario, online platforms could be strategically utilized to deliver theoretical knowledge, thereby freeing up valuable classroom time for instructors to conduct in-person skill development sessions with students [5,6].
Despite advancements in technology, digitalization efforts in the Indian dental sector have primarily focused on practical training tools like computer-aided design/ computer-aided manufacturing (CAD/CAM) and 3D printing technologies [7,8].Traditional face-to-face lectures remained the dominant method for knowledge delivery, with online learning remaining largely unexplored within the Indian dental education curriculum before the pandemic [9].
The COVID-19 pandemic has disrupted this status quo, propelling online learning to the forefront of dental education [10].This unprecedented situation necessitates a comprehensive assessment of its impact on the perceptions and experiences of both dental students and educators across India.This leads us to our central research question: "To what extent has the COVID-19 pandemic impacted the perceptions and challenges of online learning among dental students and teachers in India?"By delving into this question, we aim to shed light on the strengths, weaknesses, and areas for improvement in online learning within the context of Indian dental education.These findings will inform future curricular development, allowing for a well-considered and strategic integration of online and traditional approaches.Ultimately, this research seeks to enhance the overall educational experience for dental students.By ensuring a balanced curriculum that leverages the strengths of both online and offline learning, we can equip future dentists with the essential knowledge and practical skills necessary to thrive in a rapidly evolving healthcare landscape.

Study design
The study utilized a cross-sectional research design to collect data from 500 dental students and 150 teachers in India.An online-validated survey questionnaire was employed to gather quantitative data.The study population consisted of undergraduate and postgraduate dental students and teachers from diverse dental colleges across India.Participants were selected through purposive sampling based on their willingness and availability during the study period.Ethical principles were strictly followed, including obtaining informed consent, ensuring confidentiality of participant data, and safeguarding participant privacy.This sampling method was chosen due to practical reasons, as randomly sampling would have been resource intensive.Leveraging existing networks and professional contacts facilitated access to a varied participant pool, ensuring engagement and data quality.To enhance representativeness, participants from various dental colleges, urban and rural locations, academic levels, and age groups were included in the sample.

Questionnaire
A self-administered, English-language questionnaire developed using Google Forms was utilized to evaluate perceptions and challenges of online dental education during the COVID-19 pandemic in India [11].The questionnaire was structured around three main domains: satisfaction with online teaching, encountered problems, and comparisons between online and traditional classroom learning experiences.
In order to ensure the validity and reliability of this questionnaire within the unique context of Indian dental education, a thorough validation process was undertaken.Face validity was established through evaluation by a qualified researcher and questionnaire design specialist.Their assessment focused on the clarity, comprehensiveness, and relevance of the questions, resulting in revisions to improve clarity and minimize ambiguity in terminology, phrasing, and structure.
Content validity was ensured through the input of two subject-matter experts (SMEs) with significant experience in Indian dental education.These SMEs, who were independent of the study, assessed the questionnaire against the defined research objectives.Their feedback ensured that the questionnaire comprehensively covered the intended constructs, leading to further refinements.
Pilot testing was then conducted with a representative sample of 20 dental students and 10 teachers.This phase aimed to identify and address any remaining issues with the questionnaire's understandability, flow, and length.Based on the feedback received from the pilot test participants, minor adjustments were made to optimize the user experience.

Data analysis
Following data collection, survey responses were entered into a Microsoft Excel spreadsheet and then imported into the Statistical Package for Social Sciences (SPSS) version 25 for analysis.Descriptive statistics were employed to summarize participant characteristics such as age, course of study (undergraduate, postgraduate), place of study (town, village), and self-reported familiarity with e-learning skills.These characteristics were presented as frequencies (N) and percentages (%) to provide an overview of the sample composition.
Chi-square tests were conducted to assess potential associations between categorical variables.However, the use of the Chi-square test is contingent upon meeting the assumption of expected cell frequencies being greater than 5.In instances where expected cell frequencies fell below 5, Fisher's exact test was employed as a more appropriate alternative.Statistical significance was established at a p-value of 0.05 or less.

Participant characteristics and survey completion
A total of 500 students initiated the online survey, with a completion rate of 81.8% (n = 409).Similarly, among the 150 teachers who began the survey, 132 completed it (completion rate: 88%).To ensure a sufficient sample size for analysis, the survey period was extended beyond its original timeframe, potentially introducing a selection bias.This decision aligns with the purposive sampling methodology employed in this study.

Student perceptions Satisfaction with online learning
A significant portion (44.7%, n = 183) of students aged 18-21 reported satisfaction with online instruction.Interestingly, age did not significantly influence satisfaction levels.Undergraduates expressed higher satisfaction compared to other course levels (p = 0.001).Location also played a role, with students from both urban (41.8%, n = 79) and rural areas (45.6%, n = 73) reporting similar contentment levels (p-value = 0.034).Notably, students with advanced e-learning skills reported significantly higher satisfaction (p-value = 0.001).

Evaluation of specific aspects
Students across various age groups, locations, and course levels expressed satisfaction with the topics covered (p = 0.032 for undergraduate students, p = 0.002 for those knowledgeable about e-learning) and the instructors' efforts (particularly those aged 18-21, p = 0.001, undergraduates, p = 0.010, and students with e-learning skills, p = 0.001).However, no significant difference was observed in self-reported understanding of the subject matter based on demographics or e-learning skills.Overall, students aged 18-21 (42.7%, p = 0.001) and those with e-learning knowledge (p = 0.006) exhibited greater appreciation for the quality of teaching.

Engagement and flexibility
Among participants familiar with e-learning (specific number not provided), a significant proportion (42.9%, p-value of 0.019) felt they could effectively engage with instructors during and after online sessions, regardless of age, location, or course level.Additionally, a notable number of undergraduate students with e-learning skills (p-values of 0.039 and 0.001, respectively) appreciated the flexibility of attending online classes at their convenience.Furthermore, 40.2% of participants with e-learning skills (p-value = 0.054) found online learning beneficial, particularly for theoretical subjects lacking practical components.Notably, a majority of participants across demographics agreed that online teaching could be valuable for future mass education initiatives (data presented in Table 1).

Challenges with online learning
Despite some advantages, participants with e-learning skills (48.2%) also reported internet connectivity and speed issues.Slow internet hindered video streaming for students across all age groups (p = 0.005).Only 20.6% of participants with e-learning skills disagreed with this finding.

Interaction and collaboration
Except for those residing in rural and semi-urban areas (p = 0.022), participants did not report significant concerns about general interaction problems.However, challenges emerged regarding sound quality and group study.Poor internet connections caused sound issues for students above 21 years old (55%, p = 0.02) and those without e-learning skills (27.7%, p = 0.03).Similarly, joint or group study proved difficult for participants over 21 (55%) and those residing in rural areas (48.8%, p = 0.025).

Subject suitability
A significant portion (41%) of participants unfamiliar with e-learning skills expressed concerns about the effectiveness of online learning for subjects like mathematics, accounting, and laboratory-based courses (p = 0.077).This suggests that students perceive these subjects as requiring a more hands-on or interactive approach that may be challenging to replicate in an online environment.

Learning environment
Across all demographics, a consistent trend emerged: most participants reported feelings of isolation and a lack of belonging when learning online (data presented in Table 2).This indicates that online learning environments may not adequately foster the sense of community and social interaction typically found in traditional classrooms.Students generally favoured classroom settings for the increased engagement and interaction with teachers and classmates, qualities perceived as lacking in online environments.This preference was further supported by students with limited e-learning skills (33.7%), who agreed that classroom learning was superior and considered online teaching/learning to be less beneficial (p = 0.045).

Impact on learning
The majority of participants believed online classes had minimal impact on developing students' overall personalities and communication skills.Students with limited e-learning skills (50.6%) likened online learning to watching YouTube lectures (p = 0.061), implying a passive learning experience.This suggests online learning may not be as effective as traditional classroom settings in fostering these crucial soft skills.Despite concerns about suitability and learning environment, a significant portion of participants, particularly undergraduates (42.7%, p = 0.001), expressed satisfaction with the topics covered and the instructors' efforts in the online environment.This highlights a potential disconnect between student concerns and their actual experience with well-designed online learning.
Most undergraduates strongly agreed (49.2%, p = 0.04) that online teaching/learning is extremely useful during disasters such as the coronavirus pandemic (Table 3).This emphasizes the potential of online learning as a contingency measure for educational continuity during unforeseen circumstances.
Overall, student perceptions regarding the suitability and learning outcomes of online learning were mixed.While some found it beneficial for specific situations and expressed satisfaction with well-designed online courses, concerns existed about its effectiveness in fostering a sense of community, developing soft skills, and replicating the interactive nature of traditional classroom settings.

Advantages of online teaching
A considerable number of teachers (40%) viewed online classes as a more adaptable alternative to traditional classroom settings.Similarly, nearly half (49.2%) expressed this view regarding student accessibility.
Additionally, a significant majority (59.8%) believed online teaching offered students improved 24/7 access to learning materials.

Challenges of online teaching
Teachers reported a significant decrease (50%) in the use of standardized coursework compared to traditional classrooms.While they strongly disagreed (38%) that online teaching eliminates the need for proper lesson planning, they overwhelmingly felt it hindered creating a good interactive environment with students (87%).Furthermore, teachers believed students were less likely to ask questions in an online setting (61%) compared to a physical classroom.However, most teachers (79%) appreciated the elimination of physical travel associated with online teaching.

Suitability and effectiveness
In terms of learner level, online teaching was perceived as more suitable for advanced learners (58%) than beginners.Teachers also believed online teaching was better suited for theory-based subjects (87%) compared to laboratory-based ones.Opinions were divided regarding the optimal use of online teaching for knowledge transfer, with 39% disagreeing and 24% remaining neutral.The teachers concurred that online teaching was a valuable tool during crises like the COVID-19 pandemic, but they generally preferred face-to-face teaching under normal circumstances.Data pertaining to these findings is presented in Table 4.

Discussion
The COVID-19 pandemic necessitated a rapid shift to online learning platforms in dental education globally, including India.While this transition aimed to maintain educational continuity [12], it presented unique challenges for a country grappling with limited internet infrastructure [13].Existing disparities in access were exacerbated by the pandemic's suddenness, highlighting the need for innovative solutions tailored to the Indian context [14].
Our study aimed to understand the perceptions and challenges of online dental education among students and educators.Our findings resonate with existing research, highlighting both the advantages and limitations of online learning.Similar to previous studies, both students and educators in our research acknowledged the benefits of flexibility, improved online teaching skills, and efficient time management [15][16][17][18][19].Additionally, the significant role of online resources and social media platforms in fostering learning and interaction, as emphasized by Azer et al. (2023) and Wimardhani et al. (2023), was evident in our findings [17,19].
When compared to conventional class room teaching I feel the standardized coursework is reduced for the students Strongly Agree Neither Agree Nor Disagree 19 ( When compared to conventional class room teaching I feel there is no need for lesson planning Strongly Agree 0 ( This research explored factors influencing student satisfaction with online learning.Consistent with Shaheen et al. (2023), our results indicated higher satisfaction among younger students (aged 18-21) and those with stronger e-learning skills, suggesting a correlation with technological comfort [18].However, unlike Schlenz et al. (2023) who observed a general preference for online learning, our study did not find significant variations in satisfaction based on age, location, or field of study [15].Notably, students with advanced e-learning skills reported higher dissatisfaction with internet connectivity and speed, suggesting a potential link between heightened expectations and increased frustration with technical limitations.This aligns with observations made by Pratheebha & Jayaraman (2022), Chang et al. (2021), and Wimardhani et al. (2023) regarding student challenges in online learning environments [16,19,20].While acknowledging the quality of online instruction, many students in our study, similar to those in Chang et al. (2021), expressed feelings of isolation and a preference for the interactive elements of traditional classroom settings [20].
The transition to online learning presented specific challenges in dental education, particularly for subjects requiring hands-on experience.Deery (2020) emphasizes the need for dental schools to adapt their curricula and policies to incorporate effective distance learning methods [21].Our research reinforces this notion by highlighting the importance of a strong educator-student connection for successful online learning.In the face of these challenges, educators and administrators remain committed to creating a conducive learning environment that prioritizes adaptability.
Online learning platforms offer unique advantages.E-learning technologies empower learners to personalize their learning pace, sequence, and content, leading to improved engagement [22].Additionally, recorded online lectures provide flexibility for students to access learning materials at their convenience [23].Our research, building upon prior work by Pham (2022) and Chang et al. (2021), demonstrated a weaker association between peer-to-peer interactions and student satisfaction, consistent with findings in other online learning environments [20,24].Several factors influence the success of online education, including educator willingness to share content online, student capacity for online learning, and the quality of available digital resources [25].Political, economic, and cultural factors also significantly influence the transition from traditional to online learning [25].While acknowledging the potential for academic collaboration and remote work, many educators recognize the opportunity to integrate blended learning models into future curriculum development [26].
"Internet self-efficacy" -an individual's confidence in navigating online tasks -plays a crucial role in online learning success [27].In India, internet connectivity disparities between urban and rural areas present a challenge for both students and teachers.These connectivity issues, along with software problems and audio/video functionalities, can disrupt learning and create a frustrating experience.Institutions can mitigate these challenges by offering comprehensive internet skills training to enhance students' and educators' internet self-efficacy before implementing online courses [24].However, the pandemic's swift implementation of remote learning may have limited the availability of such training protocols.

Challenges and innovations in clinical skills development
While online learning offers numerous advantages, it presents unique challenges in dental education, particularly for subjects requiring hands-on clinical experience with patients.The absence of direct patient interaction remains a significant hurdle [21].However, several institutions are actively addressing this limitation by adopting diverse e-learning tools like flash multimedia, digitized images, virtual patient simulations, and virtual reality (VR) simulators.Research has shown the effectiveness of these tools in teaching various clinical skills, including examination, palpation, surgical procedures, and resuscitation [28].Notably, VR simulators have been found to be equally effective as live patient interactions in achieving learning objectives, offering a promising solution for overcoming limitations in online dental education.

The rise of virtual interaction and blended learning models
The COVID-19 pandemic has significantly transformed the educational landscape in dental education by introducing virtual teaching platforms.This shift has reshaped interactions between educators and students, impacting how they learn and assess progress.The rise of web-based resources has facilitated the emergence of innovative virtual interaction methods, such as student-patient simulations and peer mentoring programs.Research suggests these methods can be effective in enhancing medical students' knowledge and psychological wellbeing [29].However, this transition to online learning has also encountered obstacles, including technical difficulties, privacy concerns, reduced student engagement, and potential exacerbation of mental health issues due to social isolation [27,29,30].

Optimizing blended learning for future dental education
The unique circumstances of the COVID-19 pandemic have highlighted the importance of exploring student preferences and technical challenges to optimize blended learning models in dental education.By addressing the diverse needs of students and effectively integrating online and offline learning components, educators can foster successful learning outcomes in an ever-evolving educational environment [30].This research underscores the multifaceted nature of online dental education and emphasizes the necessity for collaborative efforts to leverage its advantages while mitigating limitations.

Building educational resilience and adaptability
The significance of these studies extends beyond immediate pandemic adaptations.They contribute to a broader understanding of learning adaptations, hybrid learning environments, digital literacy, pedagogical innovation, mental health and well-being, policy implications, and the continuous enhancement of educational practices [30].Reflecting on experiences and lessons learned during the pandemic can assist educational institutions in refining their teaching and learning approaches, ensuring greater resilience and adaptability in the face of future challenges [29].Therefore, the insights from these studies offer valuable guidance for shaping the future of dental education and broader educational practices in a postpandemic world.

Limitations and future research directions
We acknowledge limitations in our study.Employing random sampling methods in future research would be crucial to draw more widely applicable conclusions regarding perceptions and challenges in online dental education in India.Additionally, we recognize the challenges associated with relying on self-reported data, including potential social desirability bias.While acknowledging these limitations, our study adopted a people-centred approach, employing a diverse questionnaire, contextual analysis, and insightful techniques to gain a profound understanding of participants' experiences with digital instruction.However, these limitations underscore the need for further exploration, particularly in understanding the potential misalignment between outcomes of digital and in-person events from instructors' perspectives.This area warrants additional research through targeted interviews, subgroup analyses, and consideration of contextual factors, aiming to enhance our understanding of effective teaching modes and benefitting student learning outcomes.
In conclusion, the COVID-19 pandemic has accelerated the adoption of online and virtual teaching platforms in dental education, offering both opportunities and challenges.By exploring student preferences and addressing technical obstacles, educators can refine blended learning models to better cater to diverse student needs.The insights gleaned from pandemic experiences provide valuable direction for bolstering the resilience and adaptability of educational practices in a post-pandemic era.

Table 1
Satisfaction of students with respect to online teaching regarding teaching through online during the Covid 19 pandemic in India

Table 2
Problems faced by students regarding teaching through online during the Covid 19 pandemic in India

Table 3
Comparison of online verses class room teaching by the students who participated in the study during the Covid 19 pandemic in India

Table 4
Opinion of teachers regarding Online teaching during the Covid 19 pandemic in India